By Kim Furlow, Institute for Public Health
Given that COVID-19 is in the forefront of the minds of, well…everyone, here and across the world, it was no surprise that the disease was the focus of the 13th Institute for Public Health Annual Conference, Oct. 29th.
But, how prepared were we for the pandemic locally and nationally? What were the hidden costs and how effective was communication and engagement in the workforce, in schools and among underserved populations? These topics were addressed in full by experts in COVID-19 research, containment and treatment.
Following an Oct. 28th round of virtual poster sessions, the full conference kicked off on Oct. 29 with a welcome by the Larry J. Shapiro Director of the Institute for Public Health, Bill Powderly, MD. Following, was an overview of the McDonnell International Scholars Academy (hidden-cost panel co-sponsor) by Vice Chancellor for International Affairs and Director of the Academy, Kurt Dirks, PhD. The Academy leads groundbreaking research projects and prepares scholars to be effective leaders in the global community.
University Chancellor, Andrew D. Martin, PhD gave an eloquent review of how WashU has withstood the test of COVID-19 in the past seven months, and called the Institute’s event “an incredibly important conference at an incredibly important time.” He added that even though the pandemic “has affected everything we do at the university…we should be proud of what we have done.”
Dr. Powderly continued the conference introduction with an overview of the Institute for Public Health, most notably including the Institute’s partnership with Fast Track Cities, St. Louis effort to end AIDS by 2030, and efforts by the Center for Health Economics and Policy to support important statewide data for the eventual passage of Medicaid Expansion in Missouri.
Keynote Address: Health Preparedness and Response History – National – Local | Watch the video.
Keynote speaker, Alexander Garza, MD Chief Medical Officer of SSM Health and head of the St. Louis Metropolitan Pandemic Task Force, gave a well-rounded view of the history of pandemics, reminding us that Venice implemented one of the first quarantines by requiring ships of sick sailors to stay away from harbors for 40 days. Dr. Garza reflected that SARS-CoV-2 initially began in 2019 in infected bats and spread through animals, not in a Chinese medical lab. His talk ended with his warning that “COVID infection trends look scary right now” but St. Louis health leaders are working to help those who are most vulnerable. “We are developing testing centers and messaging about vaccines to address societal issues such as essential workers who cannot shelter at home,” Garza concluded.
Panel Discussion: Preparedness of the Public Health System and Infrastructure: Perspectives from university & hospital systems, local health departments and community health centers’ response | Watch the video.
Moderated by Robert Hughes, PhD, President and CEO of Missouri Foundation for Health, the panel began with Dr. Steven Lawrence. He reflected on Washington University’s development of a “public health playbook” including campus restrictions such as “no shared dorm rooms”; the development of space barriers and diagnostic test sites; an enforced mask policy and a limit on the number of people in allowed to gather in one space. Dr. Lawrence says the end result has been “no major clusters of infection” on campus.
Dr. Katie Henderson, CMO of Barnes-Jewish Hospital, spoke about how a Joint Incident Command Center with WUSTL has improved coordination of resources and centralized communications during the pandemic.
The Acting Co-Director for the Saint Louis County Department of Public Health, Spring Schmidt discussed the formation of an Emergency Operations Center, which includes hundreds of responders across agencies; PPE distribution and Covid-19 testing; and a “commonality of language and resources which are invaluable when emergency assistance is needed.”
Dr. Fredrick Echols, the Director of the City of St. Louis Department of Health reminded the audience that as the pandemic continues, we must remain mindful and aware of pre-existing inequities and implement data-driven processes to move toward racial, social and health justice.
Kelly Vollmar, director of the Jefferson Co. Health Department spoke about the importance of aligning technologies with local emergency coordinators to insure that the most up-to-date information about the pandemic is shared in a timely manner.
Karen Bradshaw, MSW, with Integrated Health Network, discussed their Community Referral Coordinator Program and its collaboration with local healthcare providers to implement 30,000 COVID-19 tests and community flu vaccines.
Panelists participated in a Q&A with the audience and all agreed: further focus on health inequities–such as providing treatment where people it–and a greater emphasis on addressing the needs of marginalized communities is necessary.
Watch the pre-recorded presentation on this topic by Dr. Stephen Liang.
Panel Discussion: Role of Data and Modeling | Watch the video.
Moderated by the Institute’s Public Health Data and Training Center Director, Randi Foraker, PhD, the panel stressed building networks and collaboration between partners and community organizations to ensure seamless transition of information between agencies and community partners–especially important during a pandemic.
Douglas Briggs with Daughterty Business Solutions discussed how his team helped provide insight into Covid-19 through dashboards that school districts can use to track absences due to the pandemic.
Paul Sorenson, director of the Regional Data Alliance discussed the challenges in sharing comprehensive info from labs and hospitals and breaking it down for public consumption.
Laura Kloos (no link), PhD, MPH with the St. Louis Regional COVID Comparative Modeling Network of the Center for Clinical Excellence at BJC HealthCare, talked about the large network of models that are being evaluated to determine susceptibility, recovery, exposure and infection in the “COVID-19 St. Louis puzzle”.
Keynote Presentation: Vaccines – Road to Recovery and Healing | Watch the video.
The second keynote was presented by Sean Whelan, PhD, the Marvin A. Brennecke Distinguished Professor of Microbiology, Washington University School of Medicine. Dr. Whelan gave a scientific overview of the current state of COVID-19 vaccine development, the concept of “herd immunity”, where vaccine trials currently stand, and how these new developments will eventually lead to recovery and healing.
Panel Discussion: Hidden Costs of the Pandemic-Local and Global Perspectives | Watch the video.
Led by moderators Rhonda BeLue, PhD Professor, College for Public Health and Social Justice; Department Chair, Health Management and Policy, Saint Louis University, and Edward Lawlor, PhD, William E. Gordon Distinguished Professor and Dean Emeritus, Brown School, Washington University in St. Louis, this panel focused on not only monetary costs of the pandemic, but also the costs related to social determinants of health, mental health and maternal health, among others.
Timothy McBride, PhD, MS Bernard Becker Professor, Brown School and co-director, Center for Health Economics and Policy at the Institute for Public Health discussed the economic fallout of COVID-19 and the devastating social impact of the COVID recession. Most notable was McBride’s assertion that it may be 2022 (4-5 yrs) before unemployment returns to pre-COVID-19 rates.
Karen Joynt-Maddox, MD, assistant professor at the WashU School of Medicine and co-director for the Institute’s Center for Health Economics and Policy said we don’t know what the long-term consequences of COVID-19 will be, however, predictions currently show that the virus will affect people with chronic illness (such as asthma, diabetes) the most. COVID-19 has and will affect access to care and could lead to long-term problems.
Jessi Gold, MD, MS and Assistant Professor, WUSTL Department of Psychiatry discussed the hidden costs of mental health and how rationed care and lack of PPE are causing anxiety, insomnia and isolation among healthcare workers. Dr. Gold also reported that 27% of WashU residents (students and others living on campus) have experienced depression.
WUSTL Professor of Pediatrics, Jason Newland, MD, MEd spoke on the hidden cost of the pandemic on children. He reported that Latino children are hospitalized eight times more often than white populations. Studies show that child abuse and neglect, mental health admissions and eating disorders are up. The good news is that schools appear to be safe and following mitigation guidelines, Newland said.
Associate Professor in the Department of Gynecology and Obstetrics at the State University of Campinas in Brazil, Maria Laura Costa do Nascimento, MD, PhD gave an overview of the effects of COVID-19 on pregnant women in Brazil. Again, disparities were mentioned, as deaths among black women are two times higher than among whites with a 4.8% positive rate of COVID-19 among pregnant women overall.
Hilary Reno, MD, PhD and associate professor in the Divisions of Infectious Diseases and Hospitalist Medicine, talked about the hidden costs of COVID-19 on sexual healthcare reporting that 28% of sexually transmitted infection and HIV testing sites closed during the initial COVID-19 shutdown while 63% sites modified services. Express visits, telehealth and partnerships among community organizations and health departments in order to share data regionally have been utilized.
George Kyei, MD, PhD, MS assistant professor of medicine in WashU’s Division of Infectious Diseases, talked about the effect of COVID-19 on HIV care in Ghana. The virus caused the need for HIV physicians to be reassigned to COVID-19 treatment. Additionally, there was a drop in visits to HIV clinics because patients feared the virus. Dr. Kyei’s team continues to study alternative ways for continued care as the pandemic continues.
Kim Thuy Seelinger, JD, a research associate professor at WashU’s Brown School and the director of the Institute’s Center for Human Rights, Gender and Migration, gave perspective on her study on relationships between COVID-19 and intimate partner violence in St. Louis, Uganda, and Chile. She reported a surge in reported domestic violence cases in April in China, Spain and Greece among other countries and studies indicate that job loss, food insecurities and women handling more childcare burdens, and increased alcohol consumption have led to an overall increase in domestic violence.
Watch the pre-recorded presentation on the hidden costs topic by Tessa Madden, MD, MPH.
Panel Discussion: The Important Role of Community Engagement & Communication | Watch the video.
Moderated by Angela Brown, MD, Professor of Medicinen in WashU’s Cardiovascular Division and co-director of the Institute’s Center for Community Health Partnership and Research (ICTS), this panel covered the importance of community engagement and communications with work peers, the public and other health organizations during a pandemic, and how various entities handled it.
Bethany Johnson-Javois, MSW and CEO of Integrated Health Network, pointed out that people are tired of the same messages and it is important to change ongoing messaging about the virus and safety measures in order to resonate. Johnson-Javois added that addressing medical mistrust is essential and that “the white coat may not be the best person to deliver this message.”
Christopher Prater, MD, MPH and WashU associate professor of medicine and pediatrics, discussed community engagement in the immigrant and refugee community during a pandemic suggesting that academic partnerships are unique and need to include mutual decision-making and data sharing. Community members doing the work and academic institutions doing the collaborating, rather than the other way around, is a good model for success, Dr. Prater said.
COVID-19 Regional Response Team Managing Director, Serena Muhammad from the St. Louis Mental Health Board, talked about the importance of connecting people in need with “credible messengers using plain language” concerning safety measures, access to services (such as those helping prevent evictions,) and mental health solutions such remembering to eat well and reducing stress during the pandemic.
The Bettie Bofinger Brown Distinguished Professor of Social Policy at the Brown School and Director of the Institute’s Harvey A. Friedman Center for Aging, Institute for Public Health, Nancy Morrow-Howell, PhD, MSW rounded out the panel with a discussion on aging and COVID-19. She reiterated that 40% of COVID-19 deaths have been in communal communities such as nursing homes. She also noted that older adults are essential workers because nearly a quarter of the American workforce is over the age of 55. Older adults are also more vigilant about protecting themselves and others against COVID-19, Morrow-Howell concluded.
Watch the pre-recorded presentation on this topic by Brian Carpenter, PhD and Beth Prusaczyk, PhD, MSW.
Dr. Bill Powderly closed out the conference by saying, “COVID-19 has been a huge challenge for our society and the true impact of this pandemic is not yet known. History may just tell us that the impact on our health and well-being, economic and financial situations will prove to be as large as during the Great Depression. We will see in the months to come.”